SKELETON OF THE UPPER LIMB L E C T U R E 2 D E N T I S T R Y 2 0 1 7 R N D R . M I C H A E L A R A Č A N S K Á , P H . D . Skeleton of the upper limb (ossa membri superioris) Thirty-four bones form the skeletal framework of each upper limb I. Shoulder girdle (cingulum membri superioris) Collar bone, clavicle – clavicula Shoulder blade – scapula II. Bones of free part of the upper limb (ossa membri superioris liberi) Arm bone – humerus Radius – radius Ulna – ulna Carpal bones – ossa carpi 8 Metacarpal bones – ossa metacarpi 5 Phalanges, hand digits – ossa digitorum manus 14 Sesamoid - 2 Clavicula (collar bone) Connects upper limb with the trunk Connection with the shoulder blade Connection with the breast bone Medial end (sternal end) extremitas sternalis (facies articularis sternalis) sternal articular facet tuberositas costalis Costal tuberosity (impressio ligamenti costoclavicularis) (impression for costoclavicular ligament) Lateral (acromial) end extremitas acromialis (facies articularis acromialis) tuberositas coracoidea (tuberculum conoideum et linea trapezoidea) conoid tubercle + trapezoid line Side orientation Clavicula (collar bone) Left one –superior view Left one –inferior view Sternal end acromial end Fracture of the collar bone https://en.wikipedia.org/wiki/Clavicle_fracture X-ray of a left clavicle fracture Scapula Margo: superior medialis lateralis angulus: superior, inferior, lateralis facies: costalis, dorsalis Connection to humerus, clavicle Facies costalis scapulae Lineae musculares (transverae) Fossa subscapularis Incisura scapulae (ligamentum transversum scapulae) Processus coracoideus Collum scapulae Cavitas glenoidalis cavitas glenoidalis tuberculum supraglenoidale (musculus biceps brachii) tuberculum infraglenoidale (musculus triceps brachii) collum scapulae Facies dorsalis scapulae spina scapulae acromion facies articularis acromii fossa supraspinata fossa infraspinata Side orientation Humerus (arm bone) Connects shoulder blade and forearm bones Proximal end Body Distal end Humerus Proximal end caput humeri collum anatomicum tuberculum majus tuberculum minus crista tuberculi majoris et minoris sulcus intertubercularis collum chirurgicum corpus - body tuberositas deltoidea sulcus nervi radialis (nervus radialis) Humerus Fracture of the midshaft ot the humerus (entrapment of radial nerve) Humerus Distal end epicondylus medialis sulcus nervi ulnaris epicondylus lateralis trochlea humeri fossa coronoidea capitulum humeri fossa radialis fossa olecrani Side orientation Radius Lateral side of the forearm Connects to the humerus Connects to the ulna Connects to the carpal bones Proximal end body Distal end Proximal end caput radii fovea capitis radii circumferentia articularis capitis radii collum radii corpus (body) tuberositas radii margo interosseus Radius Distal end processus styloideus radii facies articularis carpea radii incisura ulnaris radii Dorsal side –grooves for extensors tendons Radius Side orientation Source: https://en.wikipedia.org/wiki/Colles%27_fracture Colles' fracture of the left hand, with posterior displacement clearly visible. Fracture of the distal end of radius (Colle´s fracture) An X-ray image of a fractured radius showing the characteristic Colle's fracture with displacement and angulation of the distal end of the radius. Ulna Forearm (medial side) Connects to humerus and radius Proximal end Body Distal end Proximal end olecranon ulnae incisura trochlearis processus coronoideus incisura radialis ulnae body: tuberositas ulnae margo interosseus crista musculi supinatoris Ulna Distal end: caput ulnae circumferentia articularis capitis ulnae processus styloideus ulnae Ulna Side orientation Fracture of the ulna („parry fracture“) Ossa carpi (carpal bones) Ossa metacarpi (metacarpal bones) Ossa digitorum manus, phalanges (digits) Sesamoid bones Bones of the hand Carpal bones - Ossa carpi (8) Proximal row (from the thumb): os scaphoideum (scaphoid) (tuberculum ossis scaphoidei) os lunatum (lunate) os triquetrum (triquetrum) os pisiforme (pisiform) Ossa carpi (8) Distal row: os trapezium (trapezium) (tuberculum ossis trapezii) os trapezoideum (trapezoid) os capitatum (capitate) os hamatum (hamate) (hamulus ossis hamati) palma manus dorsum manus sulcus carpi eminentia carpi radialis (tuberculum ossis scaphoidei et trapezii) eminentia carpi ulnaris (hamulus ossis hamati et os pisiforme) sulcus carpi (retinaculum flexorum) canalis carpi Both rows of carpal bones form together an arch and with flexor retinaculum (retinaculum flexorum) form carpal tunnel for tendons of flexor muscles and median nerve (nervus medianus). Carpal tunnel syndrom nervus medianus retinaculum flexorum Ossa metacarpi (metacarpal bones I.-V.) I. II. III. IV. V. BASE - Basis ossis metacarpalis (III. MC – processus styloideus) BODY - Corpus ossis metacarpalis HEAD - Caput ossis metacarpalis Ossa sesamoidea - Sesamoid bones -in the joints between metacarpal and the basis of proximal phalanx of the thumb. I. MC – trapezium II. MC – trapezium, trapezoid, capitate III. MC – capitate IV. And V. MC – hamate Connections with basis ossis metacarpi Ossa digitorum manus, phalanges of the hand, bones of the digits Each digit (II.-V.) 3 phalanges: phalanx proximalis, media et distalis Thumb: 2 phalanges: phalanx proximalis et distalis Base - Basis phalangis (prox., media, dist.) Body - Corpus phalangis (prox., media, dist.) Head, trochles - Trochlea phalangis (prox., media, dist.) Tuberositas phalangis distalis - at the distal end there is a rough palmar surface for insertion of the tendon of the muscle –the tuberosity of the distal phalanx X-rays glenoid cavity clavicle coracoid process acromion greater tubercle lesser tubercle infraglenoid tubercle humerus Shoulder joint axial projection posterior ribs anterior ribs scapula olecranon process radial headcoronoid process humeroradial joint humerus olecranon fossa radiusulna radial tubercle medial epicondyl lateral epicondyl neck of radius humeroulnar joint proximal radioulnar joint Elbow joint axial projection humerus ulna radius olecranon trochlea coronoid process Elbow joint lateral projection head (articular circumference) ulnaradius scaphoid metacarpals proximal distal middle phalanges base head body lunate triquetrum+pisiformetrapezium trapezoideum capitatum hamatum (+hamulus) head body base phalanges 1 2 3 4 5 Hand and wrist adult sesamoid bone carpals Hand and wrist child 4,5 years old child (4 carpal bones are ossificated) 7 years old child (7 carpal bones are ossificated) 13 years old child The pictures used in this lecture were taken from following sources: •Atlas der Anatomie des Menschen/Sobotta. Putz,R., und Pabst,R. 20. Auflage. München:Urban&Schwarzenberg, 1993 •Netter: Interactive Atlas of Human Anatomy. •Naňka, Elišková: Přehled anatomie. Galén, Praha 2009. •Čihák: Anatomie I, II, III. •Drake et al: Gray´s Anatomy for Students. 2010 •Own archiv of the lecturer